Provider Demographics
NPI:1962405092
Name:JOHNSON, JILL D (MSN, APRN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 MONROE ST
Mailing Address - Street 2:BLDG G
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-885-2525
Mailing Address - Fax:419-885-3253
Practice Address - Street 1:5800 MONROE ST
Practice Address - Street 2:BLDG G
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2263
Practice Address - Country:US
Practice Address - Phone:419-885-2525
Practice Address - Fax:419-885-3253
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN139779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
341966854OtherUNITED HEALTH CARE
OH2435645Medicaid
341966854OtherFAMILY HEALTH PLAN
MI341966854OtherMICHIGAN MEDICAID
341966854OtherCIGNA
341966854OtherNATIONWIDE
341966854OtherAETNA
000000306931OtherANTHEM
341966854OtherBUCKEYE COMMUNITY HEALTH PLAN
341966854OtherHUMANA
341966854OtherPARAMOUNT
341966854OtherOHIO WORKERS COMPENSATION
341966854OtherBUCKEYE COMMUNITY HEALTH PLAN
341966854OtherUNITED HEALTH CARE
341966854OtherNATIONWIDE